Provider Demographics
NPI:1689690729
Name:KANTER, LISA R (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:KANTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 S YOSEMITE ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5139
Mailing Address - Country:US
Mailing Address - Phone:303-714-1097
Mailing Address - Fax:877-245-5761
Practice Address - Street 1:6455 S YOSEMITE ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5139
Practice Address - Country:US
Practice Address - Phone:303-714-1097
Practice Address - Fax:877-245-5761
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO187760363LF0000X
ARA01897363L00000X
TN6862363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4077289OtherBCBS TN
TN3346513Medicaid
TN3346513Medicare PIN
TN3346513Medicaid
MS500001964Medicare PIN
TNP00154730OtherRR MEDICARE
S60541Medicare UPIN
TN3346513Medicaid
MS04480769Medicaid